|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
IP
|
$7,619.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,828.56 |
| Max. Negotiated Rate |
$6,476.15 |
| Rate for Payer: Cash Price |
$3,428.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,047.60
|
| Rate for Payer: Galaxy Health WC |
$6,476.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,571.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,081.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,902.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,828.56
|
| Rate for Payer: Multiplan Commercial |
$6,095.20
|
| Rate for Payer: Networks By Design Commercial |
$4,952.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,476.15
|
|
|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
OP
|
$7,619.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$825.30 |
| Max. Negotiated Rate |
$6,476.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,571.40
|
| Rate for Payer: Cash Price |
$3,428.55
|
| Rate for Payer: Cash Price |
$3,428.55
|
| Rate for Payer: Cash Price |
$3,428.55
|
| Rate for Payer: Cigna of CA PPO |
$5,638.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Media |
$2,544.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Galaxy Health WC |
$6,476.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,571.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,714.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,173.59
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,173.59
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,544.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,081.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$825.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,828.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Multiplan Commercial |
$6,095.20
|
| Rate for Payer: Networks By Design Commercial |
$4,952.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,476.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,571.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,571.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,809.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,809.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,809.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,809.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
OP
|
$7,619.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$825.30 |
| Max. Negotiated Rate |
$6,476.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,571.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,502.83
|
| Rate for Payer: Blue Shield of California EPN |
$3,573.31
|
| Rate for Payer: Cash Price |
$3,428.55
|
| Rate for Payer: Cash Price |
$3,428.55
|
| Rate for Payer: Cigna of CA HMO |
$4,876.16
|
| Rate for Payer: Cigna of CA PPO |
$5,638.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Media |
$2,544.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Galaxy Health WC |
$6,476.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,571.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,714.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,173.59
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,173.59
|
| Rate for Payer: IEHP Medi-Cal |
$4,122.69
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$4,122.69
|
| Rate for Payer: IEHP Medicare Advantage |
$2,544.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,081.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$825.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,828.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Multiplan Commercial |
$6,095.20
|
| Rate for Payer: Networks By Design Commercial |
$4,952.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,476.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,571.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,571.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,571.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,809.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,809.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,809.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,809.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
IP
|
$7,619.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,828.56 |
| Max. Negotiated Rate |
$6,476.15 |
| Rate for Payer: Cash Price |
$3,428.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,047.60
|
| Rate for Payer: Galaxy Health WC |
$6,476.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,571.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,081.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,902.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,828.56
|
| Rate for Payer: Multiplan Commercial |
$6,095.20
|
| Rate for Payer: Networks By Design Commercial |
$4,952.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,476.15
|
|
|
HC NERVE TEASING
|
Facility
OP
|
$297.00
|
|
|
Service Code
|
CPT 88362
|
| Hospital Charge Code |
903800042
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$71.28 |
| Max. Negotiated Rate |
$1,761.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,112.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,074.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$249.14
|
| Rate for Payer: BCBS Transplant Transplant |
$178.20
|
| Rate for Payer: Blue Shield of California Commercial |
$191.86
|
| Rate for Payer: Blue Shield of California EPN |
$152.06
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cigna of CA HMO |
$190.08
|
| Rate for Payer: Cigna of CA PPO |
$219.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Dignity Health Media |
$1,074.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,181.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,074.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,074.37
|
| Rate for Payer: Galaxy Health WC |
$252.45
|
| Rate for Payer: Global Benefits Group Commercial |
$178.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$222.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,761.97
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,761.97
|
| Rate for Payer: IEHP Medi-Cal |
$1,740.48
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,740.48
|
| Rate for Payer: IEHP Medicare Advantage |
$1,074.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,074.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,353.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,439.66
|
| Rate for Payer: Multiplan Commercial |
$237.60
|
| Rate for Payer: Networks By Design Commercial |
$193.05
|
| Rate for Payer: Prime Health Services Commercial |
$252.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$178.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1,074.37
|
|
|
HC NERVE TEASING
|
Facility
IP
|
$678.00
|
|
|
Service Code
|
CPT 88362
|
| Hospital Charge Code |
903800042
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$162.72 |
| Max. Negotiated Rate |
$576.30 |
| Rate for Payer: Cash Price |
$305.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.20
|
| Rate for Payer: Galaxy Health WC |
$576.30
|
| Rate for Payer: Global Benefits Group Commercial |
$406.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$452.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.72
|
| Rate for Payer: Multiplan Commercial |
$542.40
|
| Rate for Payer: Networks By Design Commercial |
$440.70
|
| Rate for Payer: Prime Health Services Commercial |
$576.30
|
|
|
HC NEUROBEHAV STATUS W/RPT 60 MIN
|
Facility
OP
|
$1,165.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
905601804
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$106.78 |
| Max. Negotiated Rate |
$990.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$553.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$699.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Cigna of CA HMO |
$745.60
|
| Rate for Payer: Cigna of CA PPO |
$862.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$990.25
|
| Rate for Payer: Global Benefits Group Commercial |
$699.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$873.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: IEHP Medi-Cal |
$635.32
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$635.32
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$777.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$932.00
|
| Rate for Payer: Networks By Design Commercial |
$757.25
|
| Rate for Payer: Prime Health Services Commercial |
$990.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$431.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$699.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$470.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC NEUROBEHAV STATUS W/RPT 60 MIN
|
Facility
IP
|
$1,165.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
905601804
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$279.60 |
| Max. Negotiated Rate |
$990.25 |
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$466.00
|
| Rate for Payer: Galaxy Health WC |
$990.25
|
| Rate for Payer: Global Benefits Group Commercial |
$699.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$777.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.60
|
| Rate for Payer: Multiplan Commercial |
$932.00
|
| Rate for Payer: Networks By Design Commercial |
$757.25
|
| Rate for Payer: Prime Health Services Commercial |
$990.25
|
|
|
HC NEUROBEHAV STATUS W/RPT 60 MIN MCAL
|
Facility
OP
|
$1,165.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
907000032
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$106.78 |
| Max. Negotiated Rate |
$990.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$553.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$699.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: Cigna of CA HMO |
$745.60
|
| Rate for Payer: Cigna of CA PPO |
$862.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$990.25
|
| Rate for Payer: Global Benefits Group Commercial |
$699.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$873.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: IEHP Medi-Cal |
$635.32
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$635.32
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$777.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$932.00
|
| Rate for Payer: Networks By Design Commercial |
$757.25
|
| Rate for Payer: Prime Health Services Commercial |
$990.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$431.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$699.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$470.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC NEUROBEHAV STATUS W/RPT 60 MIN MCAL
|
Facility
IP
|
$1,165.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
907000032
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$279.60 |
| Max. Negotiated Rate |
$990.25 |
| Rate for Payer: Cash Price |
$524.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$466.00
|
| Rate for Payer: Galaxy Health WC |
$990.25
|
| Rate for Payer: Global Benefits Group Commercial |
$699.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$777.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.60
|
| Rate for Payer: Multiplan Commercial |
$932.00
|
| Rate for Payer: Networks By Design Commercial |
$757.25
|
| Rate for Payer: Prime Health Services Commercial |
$990.25
|
|
|
HC NEUROBEHAV STATUS W/RPT EA ADD HR
|
Facility
IP
|
$582.00
|
|
|
Service Code
|
CPT 96121
|
| Hospital Charge Code |
905601805
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$139.68 |
| Max. Negotiated Rate |
$494.70 |
| Rate for Payer: Cash Price |
$261.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.80
|
| Rate for Payer: Galaxy Health WC |
$494.70
|
| Rate for Payer: Global Benefits Group Commercial |
$349.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$388.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.68
|
| Rate for Payer: Multiplan Commercial |
$465.60
|
| Rate for Payer: Networks By Design Commercial |
$378.30
|
| Rate for Payer: Prime Health Services Commercial |
$494.70
|
|
|
HC NEUROBEHAV STATUS W/RPT EA ADD HR
|
Facility
OP
|
$582.00
|
|
|
Service Code
|
CPT 96121
|
| Hospital Charge Code |
905601805
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$133.32 |
| Max. Negotiated Rate |
$520.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$520.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$494.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$320.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$320.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$349.20
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$261.90
|
| Rate for Payer: Cash Price |
$261.90
|
| Rate for Payer: Cash Price |
$261.90
|
| Rate for Payer: Cash Price |
$261.90
|
| Rate for Payer: Cigna of CA HMO |
$372.48
|
| Rate for Payer: Cigna of CA PPO |
$430.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$494.70
|
| Rate for Payer: Dignity Health Media |
$494.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$494.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$232.80
|
| Rate for Payer: Galaxy Health WC |
$494.70
|
| Rate for Payer: Global Benefits Group Commercial |
$349.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$436.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$388.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.68
|
| Rate for Payer: Multiplan Commercial |
$465.60
|
| Rate for Payer: Networks By Design Commercial |
$378.30
|
| Rate for Payer: Prime Health Services Commercial |
$494.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$349.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$349.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$349.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$494.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$494.70
|
| Rate for Payer: Vantage Medical Group Senior |
$494.70
|
|
|
HC NEUROLYSIS OF CELIA
|
Facility
OP
|
$4,271.00
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
906764680
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$224.24 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,562.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$1,921.95
|
| Rate for Payer: Cash Price |
$1,921.95
|
| Rate for Payer: Cigna of CA PPO |
$3,160.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Media |
$1,138.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Galaxy Health WC |
$3,630.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,562.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,203.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,867.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,867.68
|
| Rate for Payer: IEHP Medi-Cal |
$1,844.90
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$1,844.90
|
| Rate for Payer: IEHP Medicare Advantage |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,848.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$224.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,025.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Multiplan Commercial |
$3,416.80
|
| Rate for Payer: Networks By Design Commercial |
$2,776.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,630.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,252.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,562.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,366.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC NEUROLYSIS OF CELIA
|
Facility
IP
|
$8,955.00
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
906764680
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,149.20 |
| Max. Negotiated Rate |
$7,611.75 |
| Rate for Payer: Cash Price |
$4,029.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,582.00
|
| Rate for Payer: Galaxy Health WC |
$7,611.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,373.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,972.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,411.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,149.20
|
| Rate for Payer: Multiplan Commercial |
$7,164.00
|
| Rate for Payer: Networks By Design Commercial |
$5,820.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,611.75
|
|
|
HC NEUROMUSCULAR JUNCTION TEST
|
Facility
IP
|
$435.00
|
|
|
Service Code
|
CPT 95937
|
| Hospital Charge Code |
900600260
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$282.75
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
|
|
HC NEUROMUSCULAR JUNCTION TEST
|
Facility
OP
|
$435.00
|
|
|
Service Code
|
CPT 95937
|
| Hospital Charge Code |
900600260
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$42.35 |
| Max. Negotiated Rate |
$1,935.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$214.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$259.17
|
| Rate for Payer: BCBS Transplant Transplant |
$261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$257.08
|
| Rate for Payer: Blue Shield of California EPN |
$204.02
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Cigna of CA HMO |
$278.40
|
| Rate for Payer: Cigna of CA PPO |
$321.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$326.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.08
|
| Rate for Payer: Heritage Provider Network Transplant |
$320.08
|
| Rate for Payer: IEHP Medi-Cal |
$316.18
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$316.18
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$282.75
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$261.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$261.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$261.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC NEWBORN HEARING RESCREENING OP
|
Facility
OP
|
$242.00
|
|
| Hospital Charge Code |
903100102
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$58.08 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$158.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$133.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$133.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.18
|
| Rate for Payer: BCBS Transplant Transplant |
$145.20
|
| Rate for Payer: Blue Shield of California Commercial |
$143.02
|
| Rate for Payer: Blue Shield of California EPN |
$113.50
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna of CA HMO |
$154.88
|
| Rate for Payer: Cigna of CA PPO |
$179.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.70
|
| Rate for Payer: Dignity Health Media |
$205.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$205.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$181.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.08
|
| Rate for Payer: Multiplan Commercial |
$193.60
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$221.00
|
| Rate for Payer: United Healthcare All Other HMO |
$215.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: Vantage Medical Group Senior |
$205.70
|
|
|
HC NEWBORN HEARING RESCREENING OP
|
Facility
IP
|
$242.00
|
|
| Hospital Charge Code |
903100102
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$58.08 |
| Max. Negotiated Rate |
$205.70 |
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.08
|
| Rate for Payer: Multiplan Commercial |
$193.60
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
|
|
HC NEWBORN HEARING SCREENING IP
|
Facility
OP
|
$211.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100100
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$50.64 |
| Max. Negotiated Rate |
$261.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$174.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.71
|
| Rate for Payer: BCBS Transplant Transplant |
$126.60
|
| Rate for Payer: Blue Shield of California Commercial |
$124.70
|
| Rate for Payer: Blue Shield of California EPN |
$98.96
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Cigna of CA HMO |
$135.04
|
| Rate for Payer: Cigna of CA PPO |
$156.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$179.35
|
| Rate for Payer: Global Benefits Group Commercial |
$126.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$158.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$261.74
|
| Rate for Payer: IEHP Medi-Cal |
$258.55
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$258.55
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$168.80
|
| Rate for Payer: Networks By Design Commercial |
$137.15
|
| Rate for Payer: Prime Health Services Commercial |
$179.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$126.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$221.00
|
| Rate for Payer: United Healthcare All Other HMO |
$215.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC NEWBORN HEARING SCREENING IP
|
Facility
IP
|
$211.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100100
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$50.64 |
| Max. Negotiated Rate |
$179.35 |
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.40
|
| Rate for Payer: Galaxy Health WC |
$179.35
|
| Rate for Payer: Global Benefits Group Commercial |
$126.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.64
|
| Rate for Payer: Multiplan Commercial |
$168.80
|
| Rate for Payer: Networks By Design Commercial |
$137.15
|
| Rate for Payer: Prime Health Services Commercial |
$179.35
|
|
|
HC NEWBORN HEARING SCREENING OP
|
Facility
OP
|
$211.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100101
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$50.64 |
| Max. Negotiated Rate |
$261.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$174.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.71
|
| Rate for Payer: BCBS Transplant Transplant |
$126.60
|
| Rate for Payer: Blue Shield of California Commercial |
$124.70
|
| Rate for Payer: Blue Shield of California EPN |
$98.96
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: Cigna of CA HMO |
$135.04
|
| Rate for Payer: Cigna of CA PPO |
$156.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$179.35
|
| Rate for Payer: Global Benefits Group Commercial |
$126.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$158.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$261.74
|
| Rate for Payer: IEHP Medi-Cal |
$258.55
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$258.55
|
| Rate for Payer: IEHP Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$168.80
|
| Rate for Payer: Networks By Design Commercial |
$137.15
|
| Rate for Payer: Prime Health Services Commercial |
$179.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$126.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$221.00
|
| Rate for Payer: United Healthcare All Other HMO |
$215.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC NEWBORN HEARING SCREENING OP
|
Facility
IP
|
$211.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100101
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$50.64 |
| Max. Negotiated Rate |
$179.35 |
| Rate for Payer: Cash Price |
$94.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.40
|
| Rate for Payer: Galaxy Health WC |
$179.35
|
| Rate for Payer: Global Benefits Group Commercial |
$126.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.64
|
| Rate for Payer: Multiplan Commercial |
$168.80
|
| Rate for Payer: Networks By Design Commercial |
$137.15
|
| Rate for Payer: Prime Health Services Commercial |
$179.35
|
|
|
HC NEWBORN SCREENING PANEL
|
Facility
IP
|
$217.00
|
|
|
Service Code
|
CPT S3620
|
| Hospital Charge Code |
903100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.08 |
| Max. Negotiated Rate |
$184.45 |
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.08
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
|
|
HC NEWBORN SCREENING PANEL
|
Facility
OP
|
$217.00
|
|
|
Service Code
|
CPT S3620
|
| Hospital Charge Code |
903100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$400.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$119.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$119.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.29
|
| Rate for Payer: BCBS Transplant Transplant |
$130.20
|
| Rate for Payer: Blue Shield of California Commercial |
$140.18
|
| Rate for Payer: Blue Shield of California EPN |
$111.10
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cigna of CA HMO |
$138.88
|
| Rate for Payer: Cigna of CA PPO |
$160.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$184.45
|
| Rate for Payer: Dignity Health Media |
$184.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$184.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$162.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.08
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$130.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.50
|
| Rate for Payer: United Healthcare All Other HMO |
$108.50
|
| Rate for Payer: United Healthcare HMO Rider |
$108.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$108.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$184.45
|
| Rate for Payer: Vantage Medical Group Senior |
$184.45
|
|
|
HC N GONNORHOEAE AMPLIFICATION
|
Facility
OP
|
$103.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912305
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.72 |
| Max. Negotiated Rate |
$309.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$309.82
|
| Rate for Payer: BCBS Transplant Transplant |
$61.80
|
| Rate for Payer: Blue Shield of California Commercial |
$66.54
|
| Rate for Payer: Blue Shield of California EPN |
$52.74
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cigna of CA HMO |
$65.92
|
| Rate for Payer: Cigna of CA PPO |
$76.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Media |
$35.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$87.55
|
| Rate for Payer: Global Benefits Group Commercial |
$61.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$77.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Heritage Provider Network Transplant |
$57.55
|
| Rate for Payer: IEHP Medi-Cal |
$56.85
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$56.85
|
| Rate for Payer: IEHP Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: Networks By Design Commercial |
$66.95
|
| Rate for Payer: Prime Health Services Commercial |
$87.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$61.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
